How to implement guidelines and models of care

In subjects older than 50 years, the presence of clinical risk factors (CRFs) for fractures or a recent fracture is the cornerstone for case finding. In patients who are clinically at high short-and long-term risk of fractures (those with a recent clinical fracture or with multiple CRFs), further assessment with bone mineral density (BMD) measurement using dual-energy absorptiometry (DXA), imaging of the spine, fall risk evaluation and laboratory exami-nation contributes to treatment decisions according to the height and modifiability of fracture risk. Treatment is available with anti-resorptive and anabolic drugs, and from the start of treatment a lifelong strategy is needed to decide about continuous, intermit-tent, and sequential therapy. Implementation of guidelines re-quires further initiatives for improving case finding, public awareness about osteoporosis and national policies on reim-bursement of assessment and therapy.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).

Automated summary

In subjects older than 50 years, the presence of clinical risk factors (CRFs) or recent fractures is crucial for identifying cases. Further evaluation including bone mineral density measurement, imaging of the spine, fall risk assessment, and laboratory examination is needed for patients who are at high short and long-term fracture risk. Treatment options include anti-resorptive and anabolic drugs, and a lifelong strategy is necessary to determine the appropriate therapy. Efforts are needed to improve case finding, raise public awareness, and establish national policies on reimbursement for assessment and therapy.